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Zborayova K, Barrenäs ML, Granåsen G, Kerber K, Salzer J. Dizziness and vertigo sick leave before and after insurance restrictions - a descriptive Swedish nationwide register linkage study. BMC Public Health 2024; 24:2591. [PMID: 39333959 PMCID: PMC11430563 DOI: 10.1186/s12889-024-20119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Vertigo and dizziness can be disabling symptoms that result in sick leave. Research regarding sickness absence due to dizziness has focused on specific vestibular diagnoses rather than the nonspecific vertigo/dizziness diagnoses. Strict sick leave regulations were introduced in Sweden in 2008. The aim of this study was to describe the vertigo/dizziness sick leave prevalence and duration considering both specific and nonspecific diagnoses according to International Classification of diseases 10th revision (ICD-10) on the 3-digit level, including the less specific "R" diagnoses. METHODS Through Swedish nationwide registers we identified individuals aged 16-64 years who during the years 2005-2018 were sickness absent > 14 consecutive days - minimum register threshold - due to vertigo/dizziness diagnoses according to ICD10 codes: specific diagnoses (H81.0, H81.1, H81.2, H81.3, H81.4, G11x) and nonspecific (R42, R26, R27, H81.9). We described the demographic characteristics, prevalence and duration of such sick-leave spells. Data were stratified according to diagnostic groups: ataxias, vestibular and nonspecific. RESULTS We identified 52,179 dizziness/vertigo sick leave episodes > 14 days in 45,353 unique individuals between 2005-2018, which constitutes 0.83% from all sick leave episodes in the given period.The nonspecific diagnoses represented 72% (n = 37741) of sick leave episodes and specific vestibular H-diagnoses 27% (n = 14083). The most common specific vestibular codes was Benign paroxysmal positional vertigo (BPPV) 9.4% (n = 4929). The median duration of sick leave was 31 days (IQR 21-61). Women on sick leave were younger than men (47 vs 51 years, p < 0.05) and had a higher proportion of nonspecific diagnoses compared with men (74% vs 70%, p < 0.05). CONCLUSIONS The vast majority of vertigo/dizziness sick leave episodes were coded as nonspecific diagnoses and occurred in women. BPPV, a curable vestibular condition, was the most common specific diagnosis. This suggests a potential for improved diagnostics. Women on sick leave due to dizziness/vertigo were younger and more often received nonspecific diagnostic codes. Future studies should determine the frequency of use of evidence based therapies and investigate further the gender differences.
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Affiliation(s)
- Katarina Zborayova
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden.
| | | | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kevin Kerber
- Department of Neurology, Ohio State University, Columbus, OH, USA
| | - Jonatan Salzer
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
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LoMartire R, Johansson P, Frumento P. Sickness Absence and Disability Pension Among Patients With Chronic Pain in Interdisciplinary Treatment or Unspecified Interventions. THE JOURNAL OF PAIN 2023; 24:2003-2013. [PMID: 37348775 DOI: 10.1016/j.jpain.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
Interdisciplinary treatment is a widely implemented strategy for the rehabilitation of patients with chronic pain. A primary treatment objective is to decrease the load on the social insurance system; however, it is questionable whether interdisciplinary treatment reduces sickness absence and disability pension (SA/DP). This register-based observational study compared SA and DP between patients in interdisciplinary treatment and unspecified interventions. With data from 7,752 Swedish specialist health care patients in their prime working age, we analyzed total net SA/DP days over 3 years from the first visit to a pain rehabilitation center. A zero-one-inflated beta model, adjusted for theoretically substantiated confounders, was used to estimate the mean differences in total days and the proportions of patients with both zero and maximum days. Compared with unspecified interventions, interdisciplinary treatment resulted in a mean (95% confidence interval) absolute increase of 50 (37, 62) total days, a 13.0% (11.3%, 14.6%) decrease in patients with zero days, and a 1.5% (.2%, 2.8%) decrease in patients with the maximum days. These findings support that interdisciplinary treatment increases SA/DP compared to less intensive interventions but reduces the risk of maximum days, implying that it is advantageous for patients with the highest absence. This highlights the need for improved patient selection procedures and the adaptation of interdisciplinary treatment programs to more adequately target SA/DP reduction. PERSPECTIVES: This study provides an accessible overview of SA/DP among working-age patients with chronic pain in Swedish specialist health care. It also shows that interdisciplinary treatment does not decrease SA/DP more than alternative treatments in most patients but is advantageous for the patients with the longest absence.
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Affiliation(s)
- Riccardo LoMartire
- Center for Clinical Research Dalarna, Uppsala University, Falun, Region Dalarna, Sweden
| | - Per Johansson
- Department of Statistics, Uppsala University, Uppsala, Region Uppsala, Sweden; Yau Mathematical Science Center, Tsinghua University, Beijing, China
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Administrative Region of Tuscany, Italy
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Salinas Fredricson A, Krüger Weiner C, Adami J, Rosén A, Lund B, Hedenberg-Magnusson B, Fredriksson L, Svedberg P, Naimi-Akbar A. Sick leave and disability pension in a cohort of TMD-patients - The Swedish National Registry Studies for Surgically Treated TMD (SWEREG-TMD). BMC Public Health 2022; 22:916. [PMID: 35534826 PMCID: PMC9082829 DOI: 10.1186/s12889-022-13329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/29/2022] [Indexed: 01/01/2023] Open
Abstract
Background Temporomandibular disorders (TMD) are common and affect approximately 10% of the adult population. TMD is usually associated with headache, pain in the masticatory muscles and/or the temporomandibular joint, clicking or crepitations during mandibular movement as well as painful and/or reduced mouth opening. This study aimed to investigate the level TMD-patients use social insurance benefits before and after their first time of diagnosis or first surgical event, compared to the general population. Furthermore, the aim was to investigate the differences in the use of social insurance benefits between surgically and non-surgically treated TMD-patients that were diagnosed in a hospital setting. Methods All Swedish citizens aged 23–59 diagnosed with TMD in a hospital setting and/or surgically treated for the condition during 1998–2016 were identified via the Swedish National Board of Health and Welfare. A non-exposed comparison cohort was collected via the Total Population Registry. Outcome and sociodemographic data were collected via Statistics Sweden. Main outcome was annual net days on sick leave and disability pension five years before (-T5) and five years after (T5) diagnosis and/or surgical treatment (T0). Regression analysis was conducted with generalized estimated equations. Results The study included 219 255 individuals (73% female) – 19 934 in the exposed cohort and 199 321 in the comparison cohort. The exposed group was classified into three subgroups: non-surgical, surgically treated once, and surgically treated twice or more. The mean annual net days of sick leave and disability pension combined during the ten-year follow-up was 61 days in the non-surgical group, 76 days in the surgically treated once group, and 104 days in the surgically treated twice or more subgroup. The corresponding number for the non-exposed comparison cohort was 32 days. Conclusion Patients diagnosed with TMD in a hospital setting are 2–3 times more dependent on the use of social benefits than the general population. The reliance on sick leave and disability pension is seen as early as five years before diagnosis, and the reliance remains after surgical treatment. The reliance is stronger in patients with several surgical interventions. These findings indicate that patients diagnosed with TMD constitute a patient group with a high burden of health issues causing long-term dependence on social security benefits.
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Affiliation(s)
- Adrian Salinas Fredricson
- Eastmaninstitutet Department of Oral and Maxillofacial Surgery, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden. .,Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.
| | - Carina Krüger Weiner
- Eastmaninstitutet Department of Oral and Maxillofacial Surgery, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden.,Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden
| | | | - Annika Rosén
- Department of Clinical Dentistry, Division of Oral and Maxillofacial Surgery, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bodil Lund
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.,Medical Unit for Reconstructive Plastic- and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Hedenberg-Magnusson
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.,Eastmaninstitutet Department of Orofacial Pain and Jaw Function, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden
| | - Lars Fredriksson
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.,Eastmaninstitutet Department of Orofacial Pain and Jaw Function, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aron Naimi-Akbar
- Eastmaninstitutet Department of Oral and Maxillofacial Surgery, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden.,Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.,Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
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LoMartire R, Dahlström Ö, Björk M, Vixner L, Frumento P, Constan L, Gerdle B, Äng BO. Predictors of Sickness Absence in a Clinical Population With Chronic Pain. THE JOURNAL OF PAIN 2021; 22:1180-1194. [PMID: 33819574 DOI: 10.1016/j.jpain.2021.03.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/02/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022]
Abstract
Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a 7-year period from a population-representative sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. Sequence analysis was used to describe the sickness absence over the complete period and to separate the patients into subgroups based on their social insurance benefits over the final 2 years. The predictive performance of features from various domains was then explored with machine learning-based modeling in a nested cross-validation procedure. Our results showed that patients on sickness absence increased from 17% 5 years before to 48% at the time of the IDT assessment, and then decreased to 38% at the end of follow-up. Patients were divided into 3 classes characterized by low sickness absence, sick leave, and disability pension, with eight predictors of class membership being identified. Sickness absence history was the strongest predictor of future sickness absence, while other predictors included a 2008 policy, age, confidence in recovery, and geographical location. Information on these features could guide personalized intervention in the specialized healthcare. PERSPECTIVE: This study describes sickness absence in patients who visited a Swedish pain specialist interdisciplinary treatment clinic during the period 2005 to 2016. Predictors of future sickness absence are also identified that should be considered when adapting IDT programs to the patient's needs.
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Affiliation(s)
- Riccardo LoMartire
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden.
| | - Örjan Dahlström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Lea Constan
- Department of Arts and Crafts, Konstfack: University of Arts, Crafts and Design, Stockholm, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Björn Olov Äng
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden; Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden
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5
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Kvillemo PK, Chen L, Bottai M, Frumento P, Almondo G, Mittendorfer-Rutz E, Friberg E, Alexanderson KAE. Sickness absence and disability pension among women with breast cancer: a population-based cohort study from Sweden. BMC Public Health 2021; 21:697. [PMID: 33836707 PMCID: PMC8033713 DOI: 10.1186/s12889-021-10703-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Women's return to work after diagnosis of breast cancer (BC) is becoming more prevalent. However, register-based national investigation on sickness absence (SA) and disability pension (DP) in BC women is lacking. The aim of the study was to explore SA and DP before and after a first BC diagnosis and the possibility to predict new cancer-related SA by using disease-related and sociodemographic factors. METHODS A longitudinal register study of the 3536 women in Sweden aged 19-64 with a first BC diagnosis in 2010 was conducted by linkage of five nationwide registers. Particularly, detailed information on SA and DP was obtained from the National Social Insurance Agency. Descriptive statistics on SA and DP 2 years before through 3 years after the BC diagnosis were performed. The risk of having a new SA spell due to BC or BC-related diagnoses was modeled using logistic regression. RESULTS The proportion of women with SA increased during the year following the BC diagnosis date and declined over the next 2 years to proportions before diagnosis. At the time of BC diagnosis, half of the women began a new SA spell > 14 days with cancer, cancer-related, or mental diagnosis. Disease-related and sociodemographic factors including occupational sector, living area, age, cancer stage, educational level, and number of previous SA days showed statistical significance (p < 0.05) in predicting a new SA around BC diagnosis. By using these factors, it was possible to correctly predict 67% of the new SA spell. CONCLUSIONS SA among women with BC was elevated mainly in the first year after diagnosis. New SA following BC diagnosis can accurately be predicted.
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Affiliation(s)
- Pia K Kvillemo
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Lingjing Chen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Frumento
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Gino Almondo
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Kristina A E Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Bae JS, Suh I, Kim JK, Jeong YS, Lim JY. Natural changes of traumatic vertebral compression fractures during the first 6 months in patients visiting for disability certificates: A retrospective observational study. Medicine (Baltimore) 2021; 100:e24142. [PMID: 33429789 PMCID: PMC7793443 DOI: 10.1097/md.0000000000024142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
To identify the natural changes of traumatic vertebral compression fractures during the first six months in patients visiting for disability certificates after conservative treatment.Data of patients who visited the rehabilitation medicine department of a university hospital for disability certificates concerning traumatic vertebral compression fractures from 2015 to 2018 were reviewed. Those who visited 180 to 210 days after injuries were included, and those who received invasive procedures for compression fractures were excluded. The anterior and posterior heights, local kyphotic angle of compression fractures, and upper and lower vertebrae on initial and follow-up images were measured and compared. Compression ratio was calculated by vertebral body compression ratio and anterior vertebral body compression percentage. Thoracic and lumbar traumatic fractures were also compared.Among 110 patients, 61 patients met the criteria. After six months, the anterior height of compression fractures decreased more than 4 mm, which implies the development of new compression fractures. The compression ratio and local kyphotic angle increased significantly without affecting the upper and lower vertebrae. Thoracic and lumbar compression fractures showed similar changes.Traumatic vertebral compression fractures change significantly during the first six months. This study could warrant 6 months of waiting for issuance of disability certificates for patients with traumatic vertebral compression fractures.
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Vaez M, Leijon O, Wikman A, Nord T, Lidwall U, Wiberg M, Alexanderson K, Gonäs L. A follow-up of the introduction of a maximum entitlement period for receiving sickness benefits in Sweden: A nationwide register-based study. Scand J Public Health 2019; 48:144-154. [PMID: 30632905 DOI: 10.1177/1403494818818258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2008, Sweden introduced a policy change to limit the number of days for sickness benefits (SB). This study aimed to elucidate the characteristics of those who reached the maximum entitlement period for receiving sickness benefits (MEPSB) and their future main source of income. Methods: All 5,309,759 individuals, aged 20-63 and residents of Sweden in 2009 were followed from July 2008 to July 2010 regarding SB-days and date of MEPSB and then categorised into three groups: I) no SB-days, II) ongoing SB-days, and III) MEPSB. Mean numbers of SB-days 2.5 years before and 2 years after the policy change and main source of income in 2011 were assessed. Associations between sociodemographic factors, occupation and paid work as main source of income were estimated by odds ratio (OR). Results: A total of 0.7% reached MEPSB in 2010. The mean numbers of SB-days before and after the policy change were higher in the MEPSB group than in the other two groups. In the MEPSB group, 14% had their main source of income from paid work in 2011; this was more common among women born in Sweden (OR = 1.29), people living with a partner and children (women OR = 1.29; men OR = 1.48), and those with occupations representing high educational levels. Conclusions: One out of seven individuals with MEPSB in 2010 had their main source of income from paid work in 2011, although they had a long-term SB before and after the policy change. Further research is warranted to address the long-term effects of this policy change.
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Affiliation(s)
- Marjan Vaez
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ola Leijon
- The Swedish Social Insurance Inspectorate, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wikman
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tora Nord
- Department of Working Life Science, Karlstad University, Karlstad, Sweden
| | - Ulrik Lidwall
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Michael Wiberg
- Department of Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
| | | | - Lena Gonäs
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Working Life Science, Karlstad University, Karlstad, Sweden
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Murley C, Yang F, Gyllensten H, Alexanderson K, Friberg E. Disposable income trajectories of working-aged individuals with diagnosed multiple sclerosis. Acta Neurol Scand 2018; 138:490-499. [PMID: 30043392 DOI: 10.1111/ane.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The economic situation of individuals diagnosed with multiple sclerosis (MS) is under studied, with the levels and sources of incomes suggested to vary with socio-demographics. We aimed to describe the diversity of disposable income (DI) trajectories among working-aged individuals with incident MS, and investigate the associations of socio-demographic characteristics with identified trajectories. MATERIALS & METHODS A population-based cohort study of all 1528 individuals first diagnosed with MS in 2008-2009 when aged 25-59, with data linked from three nationwide Swedish registers. DI was defined as net earnings plus net income from benefits. Trajectories of mean annual DI from 7 years prior to 4 years after diagnosis were identified by group-based trajectory modelling. An individual's group membership was determined by individual model-fit estimates from a multinomial logit function. Chi-squared tests and multinomial logistic regressions estimated the associations between trajectory membership and socio-demographic (sex, age, education, birth country, type of living area and family situation) and work disability (sickness absence and disability pension) characteristics. RESULTS Seven distinct DI trajectories were identified: two consistently low (50.7% of individuals); four increasing (39.0%); and one decreasing (10.3%). Socio-demographic and work disability characteristics were associated with trajectories; the increasing trajectories had older age-profiles and higher proportions of men, while university education was less common in the consistently low trajectories. CONCLUSIONS We identified high diversity in DI development within the cohort around MS diagnosis. Socio-demographic and work disability characteristics differed between the trajectories. This broader information of the economic situation is important to convey to patients.
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Affiliation(s)
- Chantelle Murley
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; SE-171 77 Stockholm Sweden
| | - Fei Yang
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; SE-171 77 Stockholm Sweden
| | - Hanna Gyllensten
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; SE-171 77 Stockholm Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; SE-171 77 Stockholm Sweden
| | - Emilie Friberg
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; SE-171 77 Stockholm Sweden
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Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The Impact of Parental and Medical Leave Policies on Socioeconomic and Health Outcomes in OECD Countries: A Systematic Review of the Empirical Literature. Milbank Q 2018; 96:434-471. [PMID: 30277601 DOI: 10.1111/1468-0009.12340] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Policy Points: Historically, reforms that have increased the duration of job-protected paid parental leave have improved women's economic outcomes. By targeting the period around childbirth, access to paid parental leave also appears to reduce rates of infant mortality, with breastfeeding representing one potential mechanism. The provision of more generous paid leave entitlements in countries that offer unpaid or short durations of paid leave could help families strike a balance between the competing demands of earning income and attending to personal and family well-being. CONTEXT Policies legislating paid leave from work for new parents, and to attend to individual and family illness, are common across Organisation for Economic Co-operation and Development (OECD) countries. However, there exists no comprehensive review of their potential impacts on economic, social, and health outcomes. METHODS We conducted a systematic review of the peer-reviewed literature on paid leave and socioeconomic and health outcomes. We reviewed 5,538 abstracts and selected 85 published papers on the impact of parental leave policies, 22 papers on the impact of medical leave policies, and 2 papers that evaluated both types of policies. We synthesized the main findings through a narrative description; a meta-analysis was precluded by heterogeneity in policy attributes, policy changes, outcomes, and study designs. FINDINGS We were able to draw several conclusions about the impact of parental leave policies. First, extensions in the duration of paid parental leave to between 6 and 12 months were accompanied by attendant increases in leave-taking and longer durations of leave. Second, there was little evidence that extending the duration of paid leave had negative employment or economic consequences. Third, unpaid leave does not appear to confer the same benefits as paid leave. Fourth, from a population health perspective, increases in paid parental leave were consistently associated with better infant and child health, particularly in terms of lower mortality rates. Fifth, paid paternal leave policies of adequate length and generosity have induced fathers to take additional time off from work following the birth of a child. How medical leave policies for personal or family illness influence health has not been widely studied. CONCLUSIONS There is substantial quasi-experimental evidence to support expansions in the duration of job-protected paid parental leave as an instrument for supporting women's labor force participation, safeguarding women's incomes and earnings, and improving child survival. This has implications, in particular, for countries that offer shorter durations of job-protected paid leave or lack a national paid leave entitlement altogether.
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Affiliation(s)
- Arijit Nandi
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Deepa Jahagirdar
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Michelle C Dimitris
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Jeremy A Labrecque
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Erin C Strumpf
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University.,Department of Economics, McGill University
| | - Jay S Kaufman
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Ilona Vincent
- Institute for Health and Social Policy, McGill University
| | - Efe Atabay
- Institute for Health and Social Policy, McGill University
| | - Sam Harper
- Institute for Health and Social Policy, McGill University.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Alison Earle
- Fielding School of Public Health, University of California
| | - S Jody Heymann
- Fielding School of Public Health, University of California
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10
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Murley C, Mogard O, Wiberg M, Alexanderson K, Karampampa K, Friberg E, Tinghög P. Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group. BMJ Open 2018; 8:e020392. [PMID: 29743325 PMCID: PMC5942406 DOI: 10.1136/bmjopen-2017-020392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/14/2018] [Accepted: 04/05/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To describe how disposable income (DI) and three main components changed, and analyse whether DI development differed from working-aged people with multiple sclerosis (MS) to a reference group from 7 years before to 4 years after diagnosis in Sweden. DESIGN Population-based cohort study, 12-year follow-up (7 years before to 4 years after diagnosis). SETTING Swedish working-age population with microdata linked from two nationwide registers. PARTICIPANTS Residents diagnosed with MS in 2009 aged 25-59 years (n=785), and references without MS (n=7847) randomly selected with stratified matching (sex, age, education and country of birth). PRIMARY AND SECONDARY OUTCOME MEASURES DI was defined as the annual after tax sum of incomes (earnings and benefits) to measure individual economic welfare. Three main components of DI were analysed as annual sums: earnings, sickness absence benefits and disability pension benefits. RESULTS We found no differences in mean annual DI between people with and without MS by independent t-tests (p values between 0.15 and 0.96). Differences were found for all studied components of DI from diagnosis year by independent t-tests, for example, in the final study year (2013): earnings (-64 867 Swedish Krona (SEK); 95% CI-79 203 to -50 528); sickness absence benefits (13 330 SEK; 95% CI 10 042 to 16 500); and disability pension benefits (21 360 SEK; 95% CI 17 380 to 25 350). A generalised estimating equation evaluated DI trajectory development between people with and without MS to find both trajectories developed in parallel, both before (-4039 SEK; 95% CI -10 536 to 2458) and after (-781 SEK; 95% CI -6988 to 5360) diagnosis. CONCLUSIONS The key finding of parallel DI trajectory development between working-aged MS and references suggests minimal economic impact within the first 4 years of diagnosis. The Swedish welfare system was responsive to the observed reductions in earnings around MS diagnosis through balancing DI with morbidity-related benefits. Future decreases in economic welfare may be experienced as the disease progresses, although thorough investigation with future studies of modern cohorts are required.
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Affiliation(s)
- Chantelle Murley
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Olof Mogard
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Michael Wiberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Korinna Karampampa
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Petter Tinghög
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Health Sciences, Swedish Red Cross University College, 141 21 Huddinge, Sweden
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11
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Wang M, Vaez M, Dorner TE, Tiihonen J, Voss M, Ivert T, Mittendorfer-Rutz E. Trajectories and characteristics of work disability before and after acute myocardial infarction. Heart 2017; 104:340-348. [PMID: 28864716 DOI: 10.1136/heartjnl-2017-311950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Scientific knowledge on work disability in terms of sickness absence and disability pension (SA/DP) among patients with acute myocardial infarction (AMI) is scarce. The study aimed to investigate trajectories of SA/DP among individuals with or without AMI and examined the associations between sociodemographic, morbidity and coronary revascularisation characteristics with such trajectories among patients with AMI. METHODS This is a population-based cohort study of 10 255 individuals aged 30-60 years who had a first AMI during 2008-2010 and were alive 30 days after AMI. Each case was matched by sociodemographics to one control without AMI. Trajectories of annual SA/DP months over a 6-year period for cases and controls were analysed by group-based trajectory modelling. Associations of characteristics with trajectory groups were estimated by Χ2 test and multinomial logistic regression. RESULTS The majority of patients (59%) had slightly increased annual levels of SA/DP (1 month) at the time of AMI, which returned to no SA/DP 2 years after the event. One group (4%) had increasing SA/DP months preceding and after AMI. Three groups showed constant SA/DP months on low (14%), medium (9%) and high (15%) levels. Sex, unemployment, education, musculoskeletal disorders and prescription of antidepressants were the strongest factors discriminating the SA/DP trajectories (R2difference=0.02-0.03, p<0.01). CONCLUSIONS The majority of patients with AMI have a good outcome in terms of low levels of work disability within 2 years after AMI. Patterns of SA/DP before AMI, sex, socioeconomic status as well as comorbid musculoskeletal and mental disorders provide crucial clinical information on work disability after AMI.
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Affiliation(s)
- Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Ernst Dorner
- Department for Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Margaretha Voss
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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12
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Rojas Y. Evictions and short-term all-cause mortality: a 3-year follow-up study of a middle-aged Swedish population. Int J Public Health 2016; 62:343-351. [PMID: 27942747 PMCID: PMC5364238 DOI: 10.1007/s00038-016-0931-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/26/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives This study sets out to explore whether being forcibly removed from one’s home is related to all-cause mortality. Methods With the help of unique register data covering all middle-aged persons registered at the Swedish Enforcement Authority with a case closed by an eviction during the period 2009–2011 (n = 2092), evictees’ deaths from any cause that occurred within 3 years of the date of the eviction are compared with the all-cause mortality of a random sample of the Swedish population (n = 426,117). The analysis is based on penalized maximum likelihood logistic regressions. Results Those who had been evicted from their homes were found to be approximately one and a half times more likely to die from any cause than those who had not been exposed to this experience (OR = 1.59), controlling for several demographic, socio-economic and health conditions prior to the date of the eviction. Conclusions The results provide support for the notion that the experience of losing one’s dwelling place should be treated as a major life event in its own right, just like other well-established social stressors.
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13
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Wang M, Alexanderson K, Runeson B, Mittendorfer-Rutz E. Morbidity and suicide mortality following sick leave in relation to changes of social insurance regulations in Sweden. Eur J Public Health 2016; 26:1061-1069. [PMID: 27418585 DOI: 10.1093/eurpub/ckw101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUNDS Stricter regulations including time limits for sick leave have been introduced in Sweden in 2008, which might have resulted in higher morbidity in those on longer sick-leave spells after the introduction. This study aimed to examine (i) the association between all-cause and diagnosis-specific sickness absence and sick-leave duration with subsequent morbidity and suicide mortality and (ii) differences in socio-demographics and morbidity in individuals on sickness absence regarding changes of social insurance regulations. METHODS A population-based prospective study was conducted of two cohorts of individuals who lived in Sweden, aged between 20 and 64 years at 31 December 2005 (n = 4 477 678) and at 31 December 2008 (n = 4 500 400), respectively. Each of the cohorts was followed regarding inpatient healthcare and suicide. Hazard ratios (HR) and 95% confidence intervals were estimated by Cox regression models. RESULTS In the multivariate analyses, all-cause and diagnosis-specific sickness absence and sick-leave duration showed higher HRs for inpatient care and suicide in both cohorts (range of HR:1.10-2.59). HRs of inpatient care and suicide among individuals with mental sickness absence 2009 were reduced more after controlling for morbidity-related covariates, than such sickness absence in 2006. Individuals with mental and somatic sickness absence and sickness absence > 180 days in 2009 had higher HRs of somatic inpatient care than those on sickness absence in 2006. CONCLUSIONS Diagnosis-specific sickness absence and long-term sickness absence in 2009 might be associated with more severe morbidity or work incapacity than in 2006 due to the stricter regulations.
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Affiliation(s)
- Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bo Runeson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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14
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Sandqvist G, Hesselstrand R, Petersson IF, Kristensen LE. Work Disability in Early Systemic Sclerosis: A Longitudinal Population-based Cohort Study. J Rheumatol 2015; 42:1794-800. [PMID: 26233502 DOI: 10.3899/jrheum.150023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study work disability (WD) with reference to levels of sick leave and disability pension in early systemic sclerosis (SSc). METHODS Patients with SSc living in the southern part of Sweden with onset of their first non-Raynaud symptom between 2003 and 2009 and with a followup of 36 months were included in a longitudinal study. Thirty-two patients (26 women, 24 with limited SSc) with a median age of 47.5 years (interquartile range 43-53) were identified. WD was calculated in 30-day intervals from 12 months prior to disease onset until 36 months after, presented as the prevalence of WD per year (0-3) and as the period prevalence of mean net days per month (± SD). Comparisons were made between patients with different disease severity and sociodemographic characteristics, and between patients and a reference group (RG) from the general population. RESULTS Seventy-eight percent had no WD 1 year prior to disease onset, which decreased to 47% after 3 years. The relative risk for WD in patients with SSc compared with RG was 0.95 (95% CI 0.39-2.33) at diagnosis, and increased to 2.41 (1.28-4.55) after 3 years. There were no significant correlations between WD and disease severity, but between WD and years at workplace (rs = -0.72; p = 0.002), education (rs = -0.51; p = 0.004), and sickness absence the month before disease onset (rs = 0.58; p = 0.001), respectively. CONCLUSION Considerable increase in WD was noted 3 years after disease onset. Limited education, fewer years at workplace, and sickness absence before disease onset may be risk factors for sustained WD.
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Affiliation(s)
- Gunnel Sandqvist
- From the Department of Clinical Sciences, Section of Rheumatology, and Orthopedics, Department of Clinical Sciences, Lund University; Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.G. Sandqvist, RegOT, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University; R. Hesselstrand, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University; I.F. Petersson, MD, PhD, Orthopedics, Department of Clinical Sciences, Lund University, and Epidemiology and Register Centre South, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital.
| | - Roger Hesselstrand
- From the Department of Clinical Sciences, Section of Rheumatology, and Orthopedics, Department of Clinical Sciences, Lund University; Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.G. Sandqvist, RegOT, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University; R. Hesselstrand, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University; I.F. Petersson, MD, PhD, Orthopedics, Department of Clinical Sciences, Lund University, and Epidemiology and Register Centre South, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital
| | - Ingemar F Petersson
- From the Department of Clinical Sciences, Section of Rheumatology, and Orthopedics, Department of Clinical Sciences, Lund University; Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.G. Sandqvist, RegOT, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University; R. Hesselstrand, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University; I.F. Petersson, MD, PhD, Orthopedics, Department of Clinical Sciences, Lund University, and Epidemiology and Register Centre South, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital
| | - Lars Erik Kristensen
- From the Department of Clinical Sciences, Section of Rheumatology, and Orthopedics, Department of Clinical Sciences, Lund University; Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden; Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.G. Sandqvist, RegOT, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University; R. Hesselstrand, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University; I.F. Petersson, MD, PhD, Orthopedics, Department of Clinical Sciences, Lund University, and Epidemiology and Register Centre South, Skåne University Hospital; L.E. Kristensen, MD, PhD, Department of Clinical Sciences, Section of Rheumatology, Lund University, and Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital
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15
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Lundh MH, Lampic C, Nordin K, Ahlgren J, Bergkvist L, Lambe M, Berglund A, Johansson B. Sickness absence and disability pension following breast cancer - A population-based matched cohort study. Breast 2014; 23:844-51. [PMID: 25305791 DOI: 10.1016/j.breast.2014.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/21/2014] [Accepted: 09/08/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare sickness absence and disability pension in a population-based cohort of women with breast cancer (n = 463) from 1 year pre-diagnosis until 3 years post-diagnosis with a matched control group (n = 2310), and to investigate predictors of sickness absence during the 2nd and 3rd year post-diagnosis. RESULTS Following breast cancer, the proportion of disease-free women with sickness absence decreased post-diagnosis (1st-3rd year; 78%-31%-19%), but did not reach the pre-diagnostic level (14%; P < 0.05). Post-diagnosis, patients were more likely than controls to be sickness absent (1st-3rd year; P < 0.001). No between-group differences were observed for disability pension post-diagnosis (P > 0.05). Among patients, chemotherapy, baseline fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd, 3rd, and 2nd and 3rd year post-diagnosis, respectively (P < 0.05). CONCLUSIONS Breast cancer is associated with increased sickness absence 3 years post-diagnosis. In a clinical setting, prevention and treatment of side effects are important in reducing long-term consequences.
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Affiliation(s)
- Marie Høyer Lundh
- Regional Cancer Centre, Uppsala University Hospital, SE-751 85 Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden.
| | - Claudia Lampic
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 23300, SE-141 83 Huddinge, Sweden
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden; Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, NO-5020 Bergen, Norway
| | - Johan Ahlgren
- Department of Oncology, Örebro University Hospital, SE-70185 Örebro, Sweden; Centre for Research and Development, Uppsala University, County of Gävleborg, SE-801 88 Gävle, Sweden
| | - Leif Bergkvist
- Department of Surgery and Centre for Clinical Research, Uppsala University, Västmanland County Hospital, SE-721 89 Västerås, Sweden
| | - Mats Lambe
- Regional Cancer Centre, Uppsala University Hospital, SE-751 85 Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden
| | - Anders Berglund
- Regional Cancer Centre, Uppsala University Hospital, SE-751 85 Uppsala, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
| | - Birgitta Johansson
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
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Gustafsson K, Aronsson G, Marklund S, Wikman A, Floderus B. Peripheral labour market position and risk of disability pension: a prospective population-based study. BMJ Open 2014; 4:e005230. [PMID: 25142263 PMCID: PMC4139627 DOI: 10.1136/bmjopen-2014-005230] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate what impact individuals' position in a labour market core-periphery structure may have on their risk of disability pension (DP) in general and specifically on their risk of DP based on mental or musculoskeletal diagnoses. METHODS The study comprised 45,567 individuals who had been interviewed for the annual Swedish Surveys of Living Conditions (1992-2007). The medical DP diagnoses were obtained from the Swedish Social Insurance Agency (1993-2011). The assumed predictors were studied in relation to DP by Cox's proportional hazards regression. The analyses were stratified on sex and age, controlling for social background and self-reported long-standing illness at baseline. RESULTS All three indicators underlying the categorisation of the core-periphery structure: employment income, work hours and unemployment, increased the risk of DP in all strata. The risk of DP tended to increase gradually the more peripheral the labour market position was. The risk estimates for DP in general and for DP based on mental diagnoses were particularly high among men aged 20-39 years. CONCLUSIONS The core-periphery position of individuals, representing their labour market attachment, was found to be a predictor of future DP. The association was most evident among individuals below 40 years of age with regard to DP based on mental diagnoses. This highlights the need for preventative measures that increase the participation of young people in working life.
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Affiliation(s)
- Klas Gustafsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Aronsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Staffan Marklund
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wikman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Floderus
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Affiliation(s)
- Ulrik Lidwall
- Statistical Analysis Unit, Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden and
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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